Minim Invasive Neurosurg 2010; 53(4): 159-163
DOI: 10.1055/s-0030-1268415
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Value of Endoscopic Third Ventriculostomy instead of Shunt Revision

J. Baldauf1 , M. J. Fritsch1 , J. Oertel2 , M. R. Gaab3 , H. Schröder1
  • 1Department of Neurosurgery, Ernst-Moritz-Arndt University, Greifswald, Germany
  • 2Department of Neurosurgery, Universitaetsmedizin, Mainz, Germany
  • 3Department of Neurosurgery, Hospital Hannover Nordstadt, Hannover, Germany
Further Information

Publication History

Publication Date:
03 December 2010 (online)

Abstract

Background: The purpose of this study was to analyze the value of endoscopic third ventriculostomy (ETV) in patients with shunt malfunction or infection.

Methods: ETV was performed in 263 patients in Greifswald between 1993 and 2008. We reviewed the data of all patients with previous shunts who underwent ETV instead of shunt revision. The procedure was successful when subsequent shunt implantation was avoided.

Results: Neuroendoscopy was performed in 30/31 previously shunted patients. The average age of the patients was 26.4 years ranging from 6 months to 69 years (male/female ratio: 18/12). The primary cause of hydrocephalus was aqueductal stenosis in 11, myelomeningocele in 5, posthemorrhagic in 5, postmeningitic in 3, tumor-related obstruction in 2, supracerebellar arachnoid cyst in 2, posttraumatic in 1 and a complex congenital hydrocephalus in 1. ETV was successful in 18 patients (60%) with a mean follow-up period of 51 months. 12 patients (40%) did not benefit from ETV and required a permanent shunt. 11 of them received the shunt within 3 months after failed ETV. ETV failed in all children <2 years of age. A benefit of ETV without subsequent shunt procedures was recognized in 18/27 (66.7%) with an obstructive and 0/3 (0%) patients with a communicating cause of the hydrocephalus. Complications occurred in 2 patients (6.7%).

Conclusions: ETV is a potential treatment option when shunts fail in patients with obstructive hydrocephalus. If MR imaging shows no obstruction, a shunt revision is recommended. Patients with a posthemorrhagic and postmeningitic hydrocephalus are poor candidates for ETV.

References

  • 1 Schroeder HW, Oertel J, Gaab MR. Endoscopic treatment of cerebrospinal fluid pathway obstructions.  Neurosurgery. 2008;  62 (6 Suppl 3) 1084-1092
  • 2 Jones RF, Stening WA, Kwok BC. et al . Third ventriculostomy for shunt infections in children.  Neurosurgery. 1993;  32 855-859
  • 3 Buxton N, Macarthur D, Robertson I. et al . Neuroendoscopic third ventriculostomy for failed shunts.  Surg Neurol. 2003;  60 201-203
  • 4 Boschert J, Hellwig D, Krauss JK. Endoscopic third ventriculostomy for shunt dysfunction in occlusive hydrocephalus: long-term follow-up and review.  J Neurosurg. 2003;  98 1032-1039
  • 5 Hader WJ, Walker RL, Myles ST. et al . Complications of endoscopic third ventriculostomy in previously shunted patients.  Neurosurgery. 2008;  63 (1 Suppl 1) ONS168-ONS174
  • 6 Cinalli G, Salazar C, Mallucci C. et al . The role of endoscopic third ventriculostomy in the management of shunt malfunction.  Neurosurgery. 1998;  43 1323-1327
  • 7 O’Brien DF, Javadpour M, Collins DR. et al . Endoscopic third ventriculostomy: an outcome analysis of primary cases and procedures performed after ventriculoperitoneal shunt malfunction.  J Neurosurg. 2005;  103 (5 Suppl) 393-400
  • 8 Woodworth G, McGirt MJ, Thomas G. et al . Prior CSF shunting increases the risk of endoscopic third ventriculostomy failure in the treatment of obstructive hydrocephalus in adults.  Neurol Res. 2007;  29 27-31
  • 9 Yamamoto M, Oka K, Ikeda K. et al . Percutaneous flexible neuroendoscopic ventriculostomy in patients with shunt malfunction as an alternative procedure to shunt revision.  Surg Neurol. 1994;  42 218-223
  • 10 Grunert P, Charalampaki P, Hopf N. et al . The role of third ventriculostomy in the management of obstructive hydrocephalus.  Minim Invas Neurosurg. 2003;  46 16-21
  • 11 Gangemi M, Mascari C, Maiuri F. et al . Long-term outcome of endoscopic third ventriculostomy in obstructive hydrocephalus.  Minim Invas Neurosurg. 2007;  50 265-269
  • 12 Choi JU, Kim DS, Kim SH. Endoscopic surgery for obstructive hydrocephalus.  Yonsei Med J. 1999;  40 600-607
  • 13 Cinalli G, Sainte-Rose C, Chumas P. et al . Failure of third ventriculostomy in the treatment of aqueductal stenosis in children.  Neurosurg Focus. 1999;  6 e3
  • 14 Jones RF, Kwok BC, Stening WA. et al . The current status of endoscopic third ventriculostomy in the management of non-communicating hydrocephalus.  Minim Invas Neurosurg. 1994;  37 28-36
  • 15 Siomin V, Cinalli G, Grotenhuis A. et al . Endoscopic third ventriculostomy in patients with cerebrospinal fluid infection and/or hemorrhage.  J Neurosurg. 2002;  97 519-524
  • 16 Blasberg R, Johnson D, Fenstermacher J. Absorption resistance of cerebrospinal fluid after subarachnoid hemorrhage in the monkey; effects of heparin.  Neurosurgery. 1981;  9 686-691
  • 17 Dorai Z, Hynan LS, Kopitnik TA. et al . Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage.  Neurosurgery. 2003;  52 763-769
  • 18 Ellington E, Margolis G. Block of arachnoid villus by subarachnoid hemorrhage.  J Neurosurg. 1969;  30 651-657
  • 19 Brockmeyer D, Abtin K, Carey L. et al . Endoscopic third ventriculostomy: an outcome analysis.  Pediatr Neurosurg. 1998;  28 236-240
  • 20 Teo C, Jones R. Management of hydrocephalus by endoscopic third ventriculostomy in patients with myelomeningocele.  Pediatr Neurosurg. 1996;  25 57-63
  • 21 Spennato P, Cinalli G, Ruggiero C. et al . Neuroendoscopic treatment of multiloculated hydrocephalus in children.  J Neurosurg. 2007;  106 (1 Suppl) 29-35
  • 22 Cinalli G. Alternatives to shunting.  Childs Nerv Syst. 1999;  15 (11–12) 718-731
  • 23 Johnston I, Teo C. Disorders of CSF hydrodynamics.  Childs Nerv Syst. 2000;  16 (10–11) 776-799
  • 24 Kulkarni AV, Drake JM, Mallucci CL. et al . Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus.  J Pediatr. 2009;  155 254-259
  • 25 Sainte-Rose C, Cinalli G, Roux FE. et al . Management of hydrocephalus in pediatric patients with posterior fossa tumors: the role of endoscopic third ventriculostomy.  J Neurosurg. 2001;  95 791-797
  • 26 Schroeder HW, Niendorf WR, Gaab MR. Complications of endoscopic third ventriculostomy.  J Neurosurg. 2002;  96 1032-1040
  • 27 Hopf NJ, Grunert P, Fries G. et al . Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures.  Neurosurgery. 1999;  44 795-804
  • 28 Fritsch MJ, Doerner L, Kienke S. et al . Hydrocephalus in children with posterior fossa tumors: role of endoscopic third ventriculostomy.  J Neurosurg. 2005;  103 (1 Suppl) 40-42
  • 29 Ruggiero C, Cinalli G, Spennato P. et al . Endoscopic third ventriculostomy in the treatment of hydrocephalus in posterior fossa tumors in children.  Childs Nerv Syst. 2004;  20 828-833
  • 30 Macarthur DC, Buxton N, Punt J. et al . The role of neuroendoscopy in the management of brain tumours.  Br J Neurosurg. 2002;  16 465-470

Correspondence

J. Baldauf

Department of Neurosurgery

Ernst-Moritz-Arndt University

Sauerbruchstraße

17475 Greifswald

Germany

Phone: +49/3834/866 163

Fax: +49/3834/866 164

Email: baldauf@uni-greifswald.de